Urinary Discomfort Can Be Misdiagnosed

People - House Calls - ASK LAKE DOCTORS

October 6, 1999|By Richard T. Bosshardt, Special to The Sentinel

Question: I am a middle-aged woman and recently began to experience a great deal of burning and urgency when I urinate. I went to my gynecologist, who did some tests and said that I may have interstitial cystitis. He wants to send me to a urologist. I have never heard of this. Can you tell me more about it?

Answer: Interstitial cystitis (IC) is an unusual condition in which there is chronic inflammation of the wall of the urinary bladder. The cause of the inflammation is unknown. Some think there is a defect in the lining of the bladder, which allows urine to seep into the bladder wall, causing irritation. Unlike the more common forms of cystitis, interstitial cystitis is not caused by a bacterial infection and antibiotics are of no use in its treatment. As yet, there is no cure for this condition.

It is estimated that as many as a million people in this country suffer from IC. While men may be affected, the large majority are women. There does not appear to be any significant age or race preference. The exact numbers are hard to pin down because IC is often misdiagnosed.

Symptoms of IC include some or all of the following. There may be burning and/or pain with urination. Urgency is often present. Urinary frequency may be increased, and in severe cases, patients may urinate up to 60 times per day. In mild cases, this may be the only symptom. The pain that accompanies urination may cause the bladder to go into a spasm. Over time this can diminish the volume that the bladder can hold. Sexual intercourse is often painful as well.

While IC has been seen in association with a number of other disorders, especially some of the autoimmune disorders, such as scleroderma, there is no known connection between IC and any other illness. Diagnosis may be difficult. Because many urologists treat mainly men, they may overlook this diagnosis when evaluating women with symptoms of bladder irritation. Other illnesses that can mimic IC include bladder cancer, tuberculosis, vaginal and other infections including some sexually transmitted diseases, radiation induced cystitis and certain nerve disorders.

In evaluating a patient with possible IC, the doctor will check urine cultures to rule out a bacterial infection and check for other possible causes such as some mentioned above.

An important part of the workup is a cystoscopy. In this procedure, a lighted tube is passed, under anesthesia, through the urethra (the opening of the bladder to the outside) and the inside of the bladder can be directly examined. One of the signs of IC is the presence of small areas of bleeding within the lining of the bladder. A biopsy of the bladder lining may be done to rule out cancer.

Once a diagnosis of IC is made, a variety of treatments are available. None is uniformly effective in all patients. Treatments include mechanical distension of the bladder under anesthesia, which seems to relieve some of the symptoms. A number of medications may be placed directly into the bladder to decrease the inflammation, such as silver nitrate, dimethyl sulfoxide (DMSO) and a new medication, Elmiron.

Elmiron recently has been approved by the U.S. Food and Drug Administration for use in IC. It may be taken orally or put directly into the bladder. Studies have shown some response in up to two-thirds of patients, with around one-third reporting at least 50 percent improvement in their symptoms.

Oral medications have included anti-inflammatory drugs, anti-spasmodics, antihistamines and muscle relaxants. A new medication, Nalmefene, is now being evaluated by the FDA and is not yet widely available. Antidepressants have sometimes been used with some success.

Bladder pain may be relieved in some people by wearing a transcutaneous electric nerve stimulation (TENS) unit. This is a nerve stimulator worn by the patient, which stimulates the nerves in the spinal cord that go to the bladder. In some cases where medications have not helped, surgery has been done to try to enlarge the bladder or divert the urine away from the bladder to a loop of intestine.

Diet can play a big role in the treatment of IC. It is well-known that certain foods can aggravate the symptoms. Patients should avoid acidic foods such as coffee, chocolate, certain fruits and vegetables (cranberries, peaches, plums, apples, onions and tomatoes) and spicy foods.

Alcohol should be eliminated. All vegetable fats except olive oil should be limited or eliminated. All beans should be avoided. Even vitamins should be used with caution. Vitamin C should be buffered and vitamin E taken in powdered form, not as an oil. Avoid B vitamins except for B6.

With care and treatment, most people can adapt and live with IC. Resources are available to provide information and support.

One of these is the Interstitial Cystitis Association, which disseminates information for patients and physicians and funds research toward finding a cure. For more information, call the ICA at (301) 610-5300, or e-mail www.Ichelp.org, or write ICA, 51 Monroe St., Suite 1402, Rockville, MD 20850.